Management of high perinatal risk pregnancy with heterozygous Leiden mutation. A clinical case

This article presents a clinical case of hereditary thrombophilia associated with the heterozygous FV Leiden mutation in a pregnant woman with a burdened obstetric history. The patient was admitted to the third group hospital with a diagnosis of pregnancy 27 weeks 6 days; burdened obstetric history; uterine scar; hereditary thrombophilia associated with heterozygous factor V mutation; stage 1 grade 1 risk 1 hypertension, controlled; grade 1 alimentary obesity; grade 1 diffuse (endemic) goiter, euthyroidism; and chronic gastritis, remission. Upon admission, the patient received Sol. Enoxaparini natrii at a dosage of 0.4 ml subcutaneously twice a day, but according to the thrombodynamics test, thrombotic readiness remained. The purpose of hospitalization was to select anticoagulant therapy in a patient at high risk of perinatal loss. We found from the anamnesis that the woman’s first pregnancy ended in operative delivery on time due to progressive severe premature detachment of a normally located placenta and intrapartum fetal death.

Together with hematologists, we selected the optimal anticoagulant therapy for this patient as follows: Sol. Enoxaparini natrii at a dosage of 0.8 ml subcutaneously in the morning, then Sol. Enoxaparini natrii 0.4 ml subcutaneously in the evening, and Tab. Acidi acetylsalicylici 0.15. During this therapy, positive dynamics was noted, with normal coagulation observed during a thrombodynamic study. After selecting anticoagulant therapy, the woman was discharged from the hospital under the supervision of an obstetrician-gynecologist at the antenatal clinic and a hematologist at the Clinical Medical Center, Chita, Russia. Antenatal hospitalization was planned at 37 weeks of pregnancy. The patient was delivered by urgent caesarean section due to premature rupture of membranes at 35 weeks 1 day, given the aggravated anamnesis in this patient with the uterine scar. A live premature girl was born weighing 2410 g, 44 cm tall with an Apgar score of 8 / 8 points. In the postpartum period, given the high risk of thromboembolic complications (3 points), the patient was prescribed Sol. Enoxaparinum natrium at a dosage of 0.4 ml subcutaneously once per day for six weeks after delivery.

The presented clinical case of pregnancy and childbirth demonstrates the importance of personalization in modern medicine.